Healthcare Provider Details

I. General information

NPI: 1437406485
Provider Name (Legal Business Name): TERESA D KENDRICK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2012
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5699 GETWELL RD
SOUTHAVEN MS
38672-7312
US

IV. Provider business mailing address

PO BOX 68
TUPELO MS
38802-0068
US

V. Phone/Fax

Practice location:
  • Phone: 662-584-5097
  • Fax: 662-495-4079
Mailing address:
  • Phone: 662-584-5097
  • Fax: 662-495-4079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberR803535
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number803535
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: